Abstract
Purpose
To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia.
Clinical features
A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingooophorectomy under general anesthesia. She received a total of 500 μg of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 μg. The rest of the postoperative period was uneventful.
Conclusion
We observed an atypical case of opioid-induced rigidity in contrast to the classical syndrome, which presents at induction with high-dose opioids. This syndrome has many clinical presentations with neurologic and ventilatory signs of varying intensity. Early recognition of the syndrome and adequate treatment is crucial. If treated adequately, opioid-induced rigidity is self-limited with few complications.
Résumé
Objectif
Faire la présentation et la discussion d’un cas de rigidité induite par un opioïde avec du fentanyl à faible dose pendant le retour à la conscience après l’anesthésie.
Éléments cliniques
Une femme de 41 ans devait subir une laparotomie pour une hystérectomie abdominale totale et une salpin-go-ovariectomie bilatèrale sous anesthésie générale. Elle a reçu une dose totale de 500 μg de fentanyl en bolus iv intermittents pendant les trois heures de l’anesthésie. Au réveil, encore intubée, la patiente a présenté de la rigidité. Aucun changement des paramètres ventilatoires n’ont cependant été noté pendant cet épisode. Le seul facteur prédisposant notable était le traitement à la venlafexine, un antidépresseur qui modifie les niveaux de sérotonine et de noradrénaline. Le traitement iv avec 20 μg de naloxone a été un succès. Aucun autre incident postopératoire n’est survenu.
Conclusion
Nous avons observé un cas atypique de rigidité induite par un opioïde est temporaire et s’accompagne rarement de complications, cas différent du syndrome classique qui se présente à l’induction avec des doses élevées d’opioïdes. Ce syndrome présente de nombreux tableaux cliniques dont des signes neurologiques et ventilatoires d’intensité variable. Le diagnostic précoce du syndrome et le traitement adapté sont donc très importants. Traitée adéquatement, la rigidité induite par un opioïde se limite à quelques complications.
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Roy, S., Fortier, LP. Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine. Can J Anesth 50, 32–35 (2003). https://doi.org/10.1007/BF03020183
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DOI: https://doi.org/10.1007/BF03020183